Elevated fracture risk in women with bipolar disorder — ASN Events
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  3. Elevated fracture risk in women with bipolar disorder

Elevated fracture risk in women with bipolar disorder (#221)

Lana J Williams 1 2 , Amanda L Stuart 1 , Michael Berk 1 2 3 4 5 , Kara L Holloway-Kew 1 , Kara Anderson 1 , Shae E Quirk 1 , Kavindi Weerasinghe 1 , Julie A Pasco 1 2 6
  1. Deakin University, Geelong, VIC, Australia
  2. Barwon Health, Geelong, VICTORIA, Australia
  3. The University of Melbourne, Parkville, Australia
  4. Florey Institute of Neuroscience and Mental Health, Parkville, Australia
  5. Orygen, The National Centre of Excellence in Youth Mental Health, Centre for Youth Mental Health, Parkville, Australia
  6. Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia

Background: Physical and mental comorbidity is common in bipolar disorder, although little is known about musculoskeletal health. Thus, we aimed to investigate the association between bipolar disorder and 10-year fracture risk using the Fracture Risk Assessment Tool (FRAX®) in a population-based sample of women aged over 40 years.

Methods: Women with a history of bipolar disorder (n=85) were recruited and controls, without bipolar disorder, were drawn from the Geelong Osteoporosis Study (n=588). Bipolar disorder was confirmed using a semi-structured clinical interview (SCID-I/NP). Bone mineral density (BMD) was measured at the femoral neck using dual-energy X-ray absorptiometry (Lunar). Weight and height were measured and clinical risk factors for fracture documented by questionnaire. FRAX® scores were calculated for each participant to determine major osteoporotic fracture (MOF) and hip fracture risk, both adjusted for BMD. Linear regression models were used to test the associations between bipolar disorder and fracture risk.

Results: Age was an effect modifier in the association between bipolar disorder and fracture risk. Bipolar disorder was associated with increased risk of MOF among women aged 40-49yr [1.3 (95%CI 1.0-1.6) vs 0.9 (95%CI 0.7-1.1) %], 50-59yr [2.0 (95%CI 1.7-2.3) vs 1.6 (95%CI 1.5-1.8) %] and 60-69yr [4.0 (95%CI 3.7-4.4) vs 3.6 (95%CI 3.5-3.9], p=0.02. A similar pattern was observed for hip fracture risk (p=0.19). No differences in MOF or hip fracture risk were observed between those with and without bipolar disorder among those aged ≥70yr (p=0.62 and p=0.45, respectively), although the limited number with bipolar disorder (n=4) in this age bracket may have affected the result.

Conclusion: These data suggest bipolar disorder is associated with fracture risk in women, underscoring the importance of interdisciplinary care. Replication and research into underlying mechanisms is warranted.